Transcript Slides G2 - Collaborative Family Healthcare Association

Session # G2
How Multi-Sector Collaboration Can Help You
Prepare Your Integrated Care Site for Audits;
While Improving Patient Care and Building
Efficiency Along the Way
Valerie Krall, MA, LPA, LPC
Behavioral Health Faculty/Provider
MAHEC--Family Health Center and
Residency Program
Darren Boice, LCSW
Dir. Ambulatory Behavioral Health
Mission Health System
Eric Christian, MAEd, LPC, NCC
Dir. of Behavioral Health Integration,
Community Care of Western North
Carolina
Consultant, Center of Excellence for
Integrated Care
Jim Hartye, MD
Behavioral Health Medical Director
Mission Health System
Patty J. Wilson, Ph.D., LPC, CI
Sr. Director, Contract Performance &
Special Investigations
Smoky Mountain MCO
CFHA 18th Annual Conference
October 13-15, 2016  Charlotte, NC U.S.A.
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Faculty Disclosure
The presenters of this session have NOT had any relevant
financial relationships during the past 12 months.
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Learning Objectives
At the conclusion of this session, the
participant will be able to:
Briefly describe the NC DHHS Provider Monitoring
Tool used in behavioral health audits
Identify key partners to include in audit
preparation work groups
Identify ways to plan for behavioral health services
when utilizing a medically oriented electronic health
record
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Learning Assessment
A learning assessment is required for CE credit.
A question and answer period will be conducted
at the end of this presentation.
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Impetus for Project
Behavioral Health (BH)
providers anticipating
future Medicaid
audits
Request for clarity
regarding traditional
mental health audits
within Integrated Care
settings (IC)
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Traditional
Mental
Health
MCO
IC
Medical Practice
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Why Revisiting Standard Audit Tools is
Necessitated by IC Settings
Workflow is different from typical BH setting
Variations in where information is kept within the
record
Team approach
Electronic Medical Record (EMR) data architecture
variations
Opportunity for electronic patient signatures
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Integrated Care Team
Behavioral
Health
Providers
Medical
Providers
Administrators
Residents
Nurses and
medical assistants
Patients
“Consumers”/Families Medical
Pharmacists
Front
Desk
Records
Care
Managers
Psychiatrists
Nutritionist Practice Manager
Health Care Entity
(ACO, MCO, PLE, CCO)
Accountable Care State and Regional Partners
(Adapted from Mendenhall, Lamson, &
Hodgson, 2010)
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Collaboration for IC Audit
Independent
Integrated Practices
BH MCO
IC Audit
Hospital Owned IC
Practices
Primary Care
Managed Care Org.
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Multi-Sector Team
Core Team Members
Ad Hoc Team Members
Valerie Krall - BHP / Clinic
Chief Operating Officer / MCO
Patty Wilson - Sr. Director,
Contract Performance & Special
Investigations / MCO
Sr. Dir. of Clinical Ops / MCO
Darren Boice - Dir. Ambulatory
Behavioral Health / Hospital
IC Consultant / MCO
Eric Christian – Dir. of
Integrated BH / Primary Care
Managed Care
Compliance Officer / Hospital
Dir. of IC / MCO
Sr. Dir. Comm Collab / MCO
BH Informatics / Hospital
Med. Dir. Ambulatory / Hospital BH
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Process for Workgroup
BH
Audit
Alert
Review of
Requirements
Talk with
Colleagues
Review
Regs.
IC does not
match audit
structure
Strategize
with
Colleagues
IC Audit
Revise Audit
Approach to
Readiness
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Focus and Strengths
of Multi-Sector Team
Independent
Integrated
Practices
BH MCO
IC Audit
Hospital Owned
IC Practices
Primary Care
Managed Care
Org.
Policy: Understand and interpret standard policy and IC efficiencies
in NC Clinical Coverage Policy 8C
Workflow: Providers and consultants can speak to actualities in the
workplace
Target: Patient functionality in PCBH creates a different clinical
approach and can affect visit frequency, duration, and case longevity
Sustainability: Traditional BH workflows are in contrast with PCBH
All have a stake in the outcome: Wanting IC to survive as an integral
part of a functioning continuum of BH services
Need for pre-audit preparation!
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IC Medical Record Cross-Walk
Traditional MH Record
IC Record
1. Assessment
A. Consents
2. Service Order
B. Medications
3. Treatment Plan
C. Crisis Plan
4. Crisis Plan
D. Treatment Plan
5. Medications
E. Assessment
6. Consents
F. Service Order
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Request for Clarity from MCO
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Request for Clarity from MCO
Efficiency
Compliance
Appropriate use of brief intervention codes in IC settings?
Are six brief sessions allowed per year or per “episode of
care?”
Point in care at which specific documentation is required in
IC setting (e.g. signed treatment plans, service orders,
completed leveling tools, comprehensive vs. brief
assessments, crisis plans, documented referral)?
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MCO and Provider Dialogue
Agreed that IC settings are new territory with few
guidelines
Agreed to establish work group to review Monitoring
Tool
Created sense of being allies for common cause of
making IC model work in our community
Decreased historical experience of “us vs. them”
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Providers and Payers
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Structure and Compliance in NC
Behavioral health providers in NC will be audited every two years by
the Local Management Entity (LME)/Managed Care Organization
(MCO)
NC-DHHS utilizes the NC Routine Provider Monitoring Tool to audit
behavioral health agencies
Provider Monitoring Tool incorporates the NC-Department of
Medical Assistance (DMA) Clinical Coverage Policy for Outpatient
Behavioral Health (aka, CCP 8C) and several additional compliance
related documents
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Competing Priorities?
Integrated Care
Setting
Compliance
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COMPLIANCE
Auditing and
Monitoring are
only part of the
picture
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Focus on the Outcome(s)
 Meeting BH needs, When needed,
Where needed
 Cost savings
 Clinical
 Bridging gaps in service provision
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Post -Audit
Actual audit took place January 2016
Workgroup provided existing channels of communication
Allowed for clarification of many items
Opportunity to give feedback to MCO regarding process
BH provider presence at audit essential to helping
auditors/administrators know how/where to find BH
compliance items in a medical EHR
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Health System Complexity
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The Power of the EMR
Help BH providers be EFFICIENT
Needs of the BH provider in a Medical Record
Only document what is necessary in PCBH
Help BH Providers be COMPLIANT
Understand documentation requirements for all
payers
Build in prompts
System support to unlock the power!
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Cerner BH Documentation
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DB
Sustainability
Investing in a new model , not living off of grants
Contracting
Reimbursement
Billing codes
Compliance issues with documentation
Mundane
Crucial
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Questions
&
Discussion
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References
 NC DHHS Provider Monitoring Tools. DHHS Review Tools for LIPs Effective October 2015 12-1415.xlsx. https://www.ncdhhs.gov/document/provider-monitoring-tools
 NC Division of Medical Assistance Medicaid and Health Choice Outpatient Behavioral Health
Services Clinical Coverage Policy No. 8-C Provided by Direct-Enrolled Providers Amended Date:
August 1, 2014. http://dma.ncdhhs.gov/document/behavioral-health-clinical-coverage-policies
 CALOCUS Version 1.5 Child and Adolescent Level of Care Utilization System American Academy of
Child and Adolescent Psychiatry American Association of Community Psychiatrists Edited by:
Robert Klaehn, M.D., Kieran O’Malley, M.D., Tom Vaughan, M.D., Kristin Kroeger.
http://providersearch.mhnet.com/Portals/0/CALOCUS.pdf
 LOCUS Training Manual Level of Care Utilization System for Psychiatric and Addiction Services Adult
Version 2000 Wesley Sowers, M.D. Robert Benacci, M.A. ©1998-2003, Deerfield Behavioral Health,
Inc. (most current version).
http://www.ct.gov/dmhas/lib/dmhas/publications/CSPlocustrainingmanual.pdf
 Records Management and Documentation Manual for Providers of Publicly-Funded Mental Health,
Intellectual for Developmental Disabilities, and Substance Use Services and Local Management
Entities-Managed Care Organizations North Carolina Department of Health and Human Services
Division of Mental Health, Developmental Disabilities, and Substance Abuse Services APSM 45-2
Revised March 1, 2009; Effective April 1, 2009; Revised August 1, 2014 [DSM-5 only].
https://ncdhhs.s3.amazonaws.com/s3fs-public/documents/files/rm%26dm-manual8-1-14.pdf
 Mendenhall, T., Hodgson, J., & Lamson, A. (2010, October). Bridging the cultures of MFT and
medicine. Presentation at the Collaborative Family Healthcare Association annual conference,
Louisville, KY.
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